Children undergo many medical procedures that are anxiety provoking and painful. Research is accumulating to suggest that there are not only immediate but also delayed repercussions to untreated pediatric pain. Parents experience collateral anxiety when their children are in medical distress. A number of behavioral interventions effectively reduce children's and their parents'medical procedure-related distress. Two key ingredients of these interventions are relaxation and distraction. However, current treatments are limited by the high cost of training family members or staff to coach children during the procedures. Technology can be used to develop interventions to train and coach the child instead of burdening parents or medical staff. Further, technology has the potential to deliver highly engaging distraction for children. Primary aims of this application are to combine biofeedback and interactive computer gaming in an intervention that distracts children while simultaneously training and coaching them in deep breathing relaxation. The intervention will be refined via piloting with the cold pressor task and then thoroughly evaluated in a clinical trial with children undergoing fracture manipulation and repair. Children's anxiety and pain and their parents'anxiety will be assessed via subjective ratings, physiological indices, and behavior observational measures. Findings should inform the development of other interventions for children's distress and the software package might be applicable to a range of childhood medical and non-medical stressors. Public Health Relevance Statement: This application will develop and evaluate an interactive biofeedback computer game, which will provide distraction and relaxation training to children for anxiety and pain management. The proposed study will evaluate the intervention for children receiving fracture manipulation and casting, but the intervention should be applicable to children facing a range of stressors in and out of the medical treatment room.